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HealthPoint Add/Remove User Request & Agreement

  • Current Physician Practice Authorization and Acknowledgment
  • Confidentiality and Use Agreement
  • Add or Remove A User
  • Complete

I verify that I am an authorized principal/owner/officer of this practice.

I authorize, on behalf of the Physician Practice, the employees listed in the “Remote Users Information” attachment to be granted access to the HealthPoint.

I acknowledge that, by authorizing the following employees, Physician Practice is responsible for each employee’s use of the Systems and their compliance with the Confidentiality and Use Agreement for Access to HealthPoint (“Agreement”) including privacy and security regulations and policies as applicable. A copy of the Agreement is attached to this document.

I agree to notify PCH’s Information Technology Services Department (“PCH ITS”) at (602) 933-HELP within 24 hours of any employee’s termination. I acknowledge that access to the Systems does not carry over from one employee/employer to another upon termination, nor are employees permitted to share identification codes and passwords with or assign access to coworkers or any other party.

I agree that, in the event any employee breaches any provision of the Agreement, Physician Practice remains responsible for any such action and must notify PCH ITS as soon as practicable, but within 24 hours, of any suspected or actual breach of security, confidentiality, or the Agreement . If PCH is required to bring an action to enforce this Agreement, Physician Practice agrees to pay PCH its expenses, including reasonable attorney’s fees and court costs.


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